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Burnett %;ounty Office of Zoning Administrator 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m w <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- - <br /> ns of th Sate of Wisc O <br /> ra' v c� R S P C= w m <br /> m <br /> OWNER(Please Print) Contractor or Surveyor or Agent n IEresGSkq,_, S 3 I Address U <br /> SU <br /> Clty,State,Zip.Code City,State,Zip Code <br /> LDI'Z � �3Ci1 ' <br /> Telephone �i Z_ 3Z_ Z 3\ Telephone <br /> Permit(s)Applied for: 914 <br /> New Building •� FillinglGrading <br /> Addition Moving kNo <br /> Sanitary Camping Unit 3 <br /> Privy Subdivision S S <br /> w <br /> StructureUse: } v ` o <br /> (f ily homelcabin,garage,addition,etc.) z o <br /> 9 v <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). o <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield(DF). <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream -if within 300 ft. r <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, <br /> river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by �} <br /> the owner. J ' <br /> O <br /> E 3 <br /> v o <br /> 2 <br /> O <br /> M1nILC 4a . of <br /> `y S t�� H <br /> aR c <br /> �J a <br /> JC <br /> D 0.1•"` � 1,1 <br /> N <br /> w <br /> IN <br /> (� SPT' 24X �` LI <br /> r <br /> 0 <br /> z <br /> MW-0 Nr D D to-0 <br /> w c .m m 0 a c m <br /> n <br /> m a� �a ^;M-=am m =o.a <br /> i p <br /> i v <i p1cyo'�3 <br /> i N i m <br /> F»: In <br /> v : : oc : In <br /> o c C <br /> I we declare that this application(including an accompanyingschedule has been examined b me us and to the best of A =' <br /> ( ) PP (� 9 Y ) Y O o f p � iD f <br /> my(our) knowledge and belief it is true, correct and complete. I (we)acknowledge that I (we)am(are)responsible for the m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county off. <br /> ciak6atIaI with administering co my rdinances or ther authorized person to have access to the above described pre. <br /> mises at any reas time for th se of i p tion. m <br /> w <br /> SIGN HERE <br /> v: <br /> (si toe of owner or i contractor) <br /> ZONING ADMINISTRATOR e ' <br /> IVN Nom+ T <br /> TV ti66 <br /> TOWNSHIP PERMI S MAY BE REQUIRED :Okhi <br />